Subsidized Retiree Medical (substantially equivalent to UC retiree medical benefit; identical to TCP1 Retiree Medical)
If you are receiving a UC annuity, and transitioned on June 1, 2006 as a LANS TCP2 employee:
If you are TCP2 Active Employee who took the lump sum cash out from UC,you are ineligible for Access Only Medical benefits.
If you are a LANS New Hire after June 1, 2006:
If you meet the minimum eligibility requirements above, you must actively enroll in your retiree medical and dental benefits for continuation of coverage. Enrollment is not automatic.
To complete the enrollment process you will need to elect your medical and dental plans through Your Benefit Resources. You will receive written instruction detailing your required action after you retire. You may also contact Your Benefit Resources on-line or via phone for more information or to enroll.
Your active benefits will extend through the end of the month following your retirement. For example, if you retire on March 6 your medical and dental coverage as an active employee will not end until April 30. Your retiree medical plan would commence without interruption on May 1, if you choose to enroll.
Note: After your retirement has been processed by your Group and Human Resources at LANL, your retiree medical eligibility and relevant information will be transmitted to Your Benefit Resources on the next scheduled data file. Timing may vary, but your information should be updated within 30 days of your retirement, well before your active coverage would end.
If you experience any life events or changes in status as a retiree, you must report these changes to Your Benefit Resources within 31 days. Examples include, but are not limited to:
A life event or change in status may allow you to change your medical and dental plans, or level of coverage. You will also be able to make changes during the annual Open Enrollment period, typically held in the Fall.
Upon reaching age 65, you must either report attainment of Medicare Eligibility, or declare that you are not eligible for Medicare benefits. Enrolling in Medicare Part B is required by the plan rules, if you are eligible, and coverage may be suspended until appropriate notice is provided.
If a retiree passes away while covered under LANL retiree medical and dental benefits, the surviving spouse may continue coverage for his/her lifetime. Remarriage at a later date will not disqualify the survivor from the plans, but he/she cannot add a new spouse to the plans.
Medicare Eligibility is determined by the Social Security Administration (SSA), not LANL. Typically, you are eligible for Medicare
You should receive Medicare enrollment information from the SSA about four months prior to your 65th birthday. If you do not enroll in Part B when you are first eligible, the SSA will add a surcharge to the Part B premium. For more information, refer to Medicare & You, the national Medicare handbook, or from your local SSA office.
Note: If you are not eligible for Medicare under your own work history, it is possible that you have attained eligibility under your spouse’s work history. Please check with the SSA to verify your status.
If you are enrolled in a LANL sponsored retiree medical plan, you and your enrolled family members are required to enroll in Medicare Part B as soon as you become eligible for Medicare Part A (usually when you turn 65). Failure to comply with this regulation may result in permanent loss of your retiree medical coverage.
Regardless of your Medicare eligibility and/or enrollment, you are required to inform Your Benefit Resources of your Medicare status. Failure to provide this information could cause suspension of benefits. Your Benefit Resources will send a reminder 60 - 90 days prior to your 65th birthday. Please contact Your Benefit Resources as soon as you receive your Medicare Age Attainment Packet from the SSA to ensure uninterrupted coverage in your health plans.
All LANL-sponsored retiree medical carriers have a separate plan for Medicare enrollees (please note that Definity Health New Mexico is not an option available to retirees). The Medicare coordinated version of your medical plan may have different benefits, service areas and doctors than the non-coordinated version of the plan.
You may see any Medicare provider to obtain plan benefits. When you receive services, Medicare is the primary payer, and your coordinated plan is secondary.
If your provider “accepts assignment” he/she will accept the Medicare approved rate for services. If the amount the coordinated plan would normally pay is less than what Medicare pays, the plans pay nothing. If the amount the coordinated plan would normally pay is greater than what Medicare pays, the plans pay the difference (up to the Medicare allowable) between their normal payment and Medicare’s payment.
If your provider does not “accept assignment,” he/she can bill you for an additional amount over the Medicare allowable rate (balance billing). The coordinated plan calculates the benefit on the Medicare “limiting charge” or the plan’s allowable rate, whichever is less, and then subtracts Medicare’s payment. The coordinated plan pays the difference and you pay the balance.
Once you pay the LANL sponsored plan’s annual deductible, the plan coordinates payment with Medicare to cover a percentage of your expenses. The plans also have an annual out-of-pocket maximum. Once you have met this amount for services each year, the plan will cover your eligible expenses at 100 percent.
Participants in Access Only retiree medical are not entitled to any Part B Reimbursement. TCP2 Retirees who are eligible for subsidized retiree medical will be reimbursed just as their TCP1 counterparts. The Social Security Administration will deduct the monthly premium for Medicare Part B automatically from your Social Security check. LANL will reimburse you for the full amount of the Part B premium if you have 20 or more years of service as of May 31, 2006; or were hired prior to January 1, 1990. If you were hired on or after January 1, 1990 and have less than 20 years of service on May 31, 2006 the amount of your reimbursement will be reduced in accordance with Graduated Eligibility provisions.